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Extrication. Who Is In Charge of Patient Care?
Just wondering how many part-time, poc, and or volunteer departments struggle with this. Understanding in the fire service for years we have always had rank. You listen and report to your company officer, battalion chief etc. When your dealing with a combined department that both delivers ems and fire services do you run into problem where you have officer that are not medically trained trying to dictate operations concerning a ems incident.
Now when you are dealing with a extrication your sir medic-emt is in charge of your patient care. Your sir medic should be telling your sr firefighter in charge of extrication what he needs to best remove his patient.
I wonder how many other departments struggle with officers thinking they are in charge of everything and trying to dictate patient care to a medic. Last time I checked the medic in charge of the patient is the one liable for how that patient is treated, not the firefighter.
This has been a struggle I have seen since I have started the fire service. I think it's more of a pride issue then anything. Letting someone with no rank tell you the big Captain what he needs done.
Any thoughts.
Replies to This Discussion
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Permalink Reply by Ben Waller on
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Not necessarily. Often a simple task like holding C-spine can be delegated to someone with minimal medical training. The paramedic's hands shouldn't be tied up with C-spine.
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Permalink Reply by Tony P on
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No FETC - he's not saying that at all. The senior Paramedic will never be the IC at an MVC, he/she will be in charge of patient care and advise how they want patients to be removed - not the extrication method, the outcome. I think that he's stated how control runs here at an MVC.
Police are in charge of the scene.
Police are in charge of traffic and bystanders. They will ask Fire for help, we have more people available.
Most senior Paramedic is in charge of patient care. He/she will ask Fire for assistance with simple tasks.
Senior rescue crew member is in charge of extrication. He/she will ask how the medics want to see the patient extricated (frontwards, backwards, sideways, whatever), and ask Fire for help with simple tasks.
Senior Fire member is in charge of fire and general scene safety. He/she provides people for support tasks.
The experts in a field each do their bit and work with the others; always Police in charge, but I've never seen them trying to tell any other service how to do things. Is that a reasonable way to state it Lutan?
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I don't see it that way at all Jerry. The incident commander/controller doesn't need expert knowledge in every field, that person is the incident manager, the person who is there to give overall direction, not detailed instructions. Which is why police here have no dificulty telling the different services what to do, because they don't, they rely on each service knowing it's job and doing it.
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A simple task, as Ben said, give it to someone with minimal medical training. Having the senior medic virtually chained to that task would stop them from moving immediately to something else.
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Permalink Reply by Carson Brown on
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Well we are lucky where i work cause we are a paramedic fire dept. 70% of are dept. are medics so most of us are just as good in patient care as we are at firefighting. That is one perk of doing fire and rescue in the same dept. but it is alot more work to have both these together of course people or normally better at one or the other.
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Permalink Reply by Mark Oomkes on
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Could be mistaken on this, but if the paramedics do not make anything other than verbal contact, they are not "in charge" of patient care.
Maybe Ralph can clarify on this issue, but that is my understanding.
Anyway about it, all our firefighters\officers\chiefs are MFR or EMT-B and have the ability to treat as well as extricate. Our ALS medics do not have the gear to treat during an extrication. Normally, we determine patient removal, but will always consult with the paramedics if they think that is a good idea or not or if they want rapid extrication, etc.
We are also fortunate in that we have some firefighters who work for (as paramedics) the private ambulance companies on our department. So they can begin ALS procedures under the paramedics license while still having full gear and extrication training.
But as said, if the transporting company doesn't have extrication training and gear, they sit back and wait. Which generally they are very good about.
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Another point to ponder--and why the senior EMS person on scene isn't always the best--is regarding a rollover I was on years ago.
Car on it's side, middle of the freeway. Dep Chief went direct as he had to drive by to get to the station anyways. Calls for air ambo and tow trucks immediately to stabilize the vehicle. (Tow company was 1 mile away and has training in heavy rescue and stabilization.) Anyways, we (fire) get there, begin patient stabilization and packaging as well as extrication. ALS gets there (private ambo company, generally very good to work with) and wants to start IV's, etc. Chief (IC) allows this to happen. Air ambo gets there, the doctor and nurse jump in and start wanting to do this, that and the other thing all the while the patient is NOT extricated and we standing around with our thumbs.....well, in our armpits shall we say?
The parameds and doc and nurse get done with all their BS (which it was in this case and all the while several of us peon FF's are telling the IC he needs to tell them to get out of the way and let us get this guy out of the car, then they can do whatever they want to) and we go to pull the guy out and find that this guys arm is trapped under the vehicle. Oh !)%#(& said several of us. Start grabbing air bags while the tow truck operator chains up the vehicle and lifts the car with his boom. We throw cribbing while pulling the patient out.
Can't remember if the guy lost his arm or not, but I do know that his Golden Hour was long gone even after getting transported by chopper, and had he had internal injuries and gone downhill while they were in our way of extricating, he probably would have died on scene.
Just a reminder that the senior medical person on scene does not necessarily mean he\she should be in charge. Several of us spoke with our chief after the incident and talked it over, not sure if it helped at all. He should have yanked their butts out of the car, despite being a MFR (lowest medical licensure in MI) and senior medical person was a doctor, he had command.
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Permalink Reply by Wendy C Helms on
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We have the same rules here in NJ. If EMS is needed to climb in to stabalize the patient while extricating, then we make sure that person is geared up. Or else one of the FF/EMT's will climb in. Scene safety comes first. Gotta follow OSHA guidelines and make sure everyone goes home safe. EMT's, Paramedic's & firefighters.
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My question would then be how did all those medical people inside the car NOT notice that the arm was pinned? Sounds like they had more than enough time for a head-to-toe in there.
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Good question.
While they were at fault too, the real fault IMO lies with my former chief not doing his job as IC. We have the same state law as Ben was referring to. Fire shows up at a fire, accident, hazmat; fire is in charge. Not sure exactly how it works for crime scenes. Never seen a chief have to pull rank on the cops, although there has been some discussion about whose responsibility it is to close a road or highway-cops.
That was the only time in 20+ years that I saw something like that, otherwise our local system works very well. We all know each others capabilities and work within them without turf wars or pissing matches.
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The only time I usually see the problem of "pissing matches" is when we want the road shut down for safety of the responders & the PD don't want to do that. I've been on scene where we have literally the width of the stretcher to maneuver to and from the ambulance. State PD seem to get a bit upset about shutting down the highway sometimes.
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